Decreased Level Of Consciousness Research Articles

Clinical features, cerebrospinal fluid changes, and prognosis in Chinese patients with autoimmune encephalitis.

Autoimmune encephalitis (AE) is a rare, treatable disease of the central nervous system (CNS) caused by an antibody-related immune response. This study is to investigate the correlation of clinical features, cerebrospinal fluid (CSF) characteristics, and prognosis in patients with AE. A total of 71 patients diagnosed with antibody-positive AE were retrospectively analyzed. The patients were divided into three groups: anti-NMDAR group, anti-LGI1 group, and other types. Clinical data were collected to analyze clinical features and CSF results, and prognosis was determined by modified Rankin Scale (mRS). There was statistical difference in the incidences of decreased consciousness level (P < 0.001), memory loss (P = 0.017), speech disorders (P = 0.035), and dyskinesia (P = 0.001) in different antibodies groups. Younger age (P = 0.018), elevated CSF chloride content (P = 0.006), and white blood cells > 50/mm3 (P = 0.026) were highly correlated with ICU admission. Anti-LGI1 encephalitis had a relatively small risk for ICU admission (P = 0.034), and a lower risk of poor functional recovery (P = 0.048) and recurrence (P = 0.041). Patients with first-line treatment failure (P = 0.021) had an increased risk of poor functional recovery. Delayed treatment (P = 0.011) would increase the risk of recurrence. There are differences in age, gender, clinical characteristics, and CSF results in different subtypes of AE. First-line therapy failure would have poor functional recovery, and delayed therapy would increase the risk of relapse. Chloride ion content and white blood cell count in cerebrospinal fluid are positively correlated with the patient's exacerbation and admission to ICU. These indicators have certain clinical value for the prognosis of AE patients.

Correlation between nurses' attitude and practice toward communication with patients of decreased level of consciousness and its relationship with ethical care in ICU: A cross-sectional study.

Communication between intensive care unit (ICU) nurses and patients with decreased Level of Consciousness (DLOC) is now regarded as a difficult task. Proper communication is regarded as a crucial component of care and stems from the attitude and practice of nurses. Intensive care nurses are responsible for providing care to patients with DLOC in accordance with ethical principles because care and ethics cannot be separated. To better understand ICU nurses' attitudes and practice toward communicating with patients who have decreased levels of consciousness and how this affects the provision of ethical care, the current study was conducted. This is a cross-sectional study. Two hundred ICU nurses from southeast Iran took part in this study. Three questioners, including attitude and practice toward communicating with patients who decreased Levels of consciousness, and ethical Care were used as data collection tools. The mean score for ICU nurses' attitude, practice, and ethical care towards communicating with patients with DLOC were, respectively, 4.02 ± 0.45,2.91 ± 0.49. The findings demonstrated a very weak correlation between the ICU nurses' attitude score and communication practice for DLOC patients (p = 0.04; r = 0.14). Nurses who had a more positive attitude toward communicating with DLOC patients performed better in this area. It is suggested that nurses employed in ICUs should be monitored and judged based on how well they communicate with DLOC patients through workshops and conferences. By doing this, they would become more cognizant of the necessity for and effective methods of communication with these patients as well as the repercussions of their poor communication practice.

A rare case report of lead encephalopathy due to high blood lead level

AbstractHere we report a case of lead poisoning having a serum lead level of 412 mcg dL−1 who presented with decreasing level of consciousness and recurrent seizures. He responded well to treatment with chelation therapy.

Pediatric Stroke in the Southern Region of Iran: A Retrospective Prognostic Cohort Study.

Childhood stroke is linked to high personal costs for affected children and their families since more than half of the survivors are impaired for a long time, hampering their normal development and lifestyle. Thus, the present study aimed to evaluate the neurological developmental outcomes of children admitted to Namazi hospital, Shiraz, Iran, for ischemic and hemorrhagic stroke with a five-year follow-up. Ma a retrospective cohort study on children admitted to Namazi Hospital due to ischemic and hemorrhagic stroke during the past three years (2012-2015). The information was collected by reviewing the medical records and clinically visiting the patients on follow-up. The SPSS 21.0 software was used for statistical analysis. This is a retrospective cohort study on children admitted to Namazi hospital due to ischemic and hemorrhagic stroke during past three years (2012-2015). The information was collected by reviewing the medical records and clinically visiting the patients at the time of follow up. The SPSS 21.0 software was used for statistical analysis Settings. The patients' mean age at the time of stroke was 6.87 ± 4.60 years. The mean follow-up period was 3.5 ± 1.64 years. 53.1% of the children (N=17) were diagnosed with hemorrhagic stroke, and 46.9% (N=15) with ischemic stroke. The most frequent symptoms first presented by the study population were a decrease in the level of consciousness (LOC) (40.6%), headaches (37.5 %), and hand/arm/leg weakness (34.4%), respectively. The number of patients in the poor.and severe outcome group was 73.3% in the ischemic and 52.9% in the hemorrhagic group. Hemorrhagic stroke was slightly more frequent than ischemic stroke, and stroke was more frequent in boys. A decrease in LOC and headaches were the most common symptoms upon admission. The left sensorimotor area was the most involved in both ischemic and hemorrhagic groups. In addition, trauma was the most common cause of stroke in this study population.

Neurological Complications After Covid 19 Vaccinations: Serial Case Report

Background: COVID-19 vaccination has been carried out worldwide, with more than 5 million dose of vaccine delivered. Although declared safe, there are cases of neurological disorders after the Covid 19 vaccination. Cases: In the first case, a 20-year-old male came with decrease level of consciousness, 4 days after receiving the first dose of COVID 19 vaccine with Sinovac vaccine. MRI Brain shows acute disseminated encephalomyelitis (ADEM). In the second case, a 50-year-old male with seizures and decreased consciousness after recieving first dose of COVID-19 vaccination with Sinovac vaccine, 10 days before admission. Non contrast CT Scan and brain contrast MRI Brain revealed cerebral edema. In the third case, an 18-year-old woman had seizures and decreased consciousness one month after the first dose of COVID 19 vaccination with Sinovac. Contrast Head MRI showing focal leptomeningitis. In the fourth case, a 30-year-old male with slurred speech and right-sided weakness. Three months before admission, he had fever, headache, and tingling of the right limbs a few days after the first dose of COVID 19 vaccination with Sinova MRI Brain Contrast shows ADEM lesion Discussion: The mechanism of neurological disorders concerning COVID 19 vaccination is still unclear. Neurological complications after vaccination weaken the effort of vaccination, but can be used as a precaution and assess prognosis while waiting for further confirmation from large epidemiological studies and meta-analyses. Until now, it is believed that the COVID-19 vaccine has important benefits and is a hope for ending the COVID-19 pandemic.

DIPG-33. Treating Pediatric Diffuse Intrinsic Pontine Glioma with Brain Radiation and Temozolomide: A Case Report

Abstract Diffuse Intrinsic Pontine Gliomas (DIPG) is a rare and highly aggressive central nervous system tumour arising from glial cells which occur mostly in children. It remains a potentially deadly cancer despite treatment, with the highest mortality rate, in which most children die within 1-year of diagnosis. Radiation therapy might improve the clinical symptoms, but the results are temporary, with tumor progression typically occurring months post radiation, whereas chemotherapy remains controversial. Here we present a case report of a patient with DIPG Indonesia and how we diagnose and currently treat it. An eight years-old boy presented with decrease level of consciousness with headache, limb weakness, slurred speech, double vision, hemifacial weakness, paraplegia, and disequilibrium which worsened two weeks prior to admission. He was initially noted to have a medially inverted left eye two months prior to admission. On physical examination, there was a N.VI and N.VII palsy, hyperreflexia, paraplegia, and nystagmus. Head MRI demonstrated a solid with minimal enhancement after contrast administration in the left pons region extending into mesencephalon with cystic component and flat floor of fourth ventricle sign, causing hydrocephalus, suggestive diffuse intrinsic pontine glioma. He was given fractionated focal intensity modulated radiation therapy (IMRT) to the tumor along with 5 mm margins with a total dose of 54 Gy. 1.8 Gy fractions, given once daily for 5 days per week over a period of 6 weeks. Supportive care in the form of corticosteroids is used to treat the peri-tumoral edema. There was a short period of motoric improvement. But then the disease progressed with the latest head CT showed hydrocephalus formation with increased size of mass. He is treated with chemotherapy using Temozolomide, and currently alive after 3 months post diagnosis. Keywords: childhood brain tumour, Diffuse Intrinsic Pontine Glioma, radiation therapy

Acute ischemic stroke in a university hospital intensive care unit: 1-year costs and outcome.

Background and purposeLittle is currently known about the cost‐effectiveness of intensive care of acute ischemic stroke (AIS). We evaluated 1‐year costs and outcome for patients with AIS treated in the intensive care unit (ICU).Materials and methodsA single‐center retrospective study of patients admitted to an academic ICU with AIS between 2003 and 2013. True healthcare expenditure was obtained up to 1 year after admission and adjusted to consumer price index of 2019. Patient outcome was 12‐month functional outcome and mortality. We used multivariate logistic regression analysis to identify independent predictors of favorable outcomes and linear regression analysis to assess factors associated with costs. We calculated the effective cost per survivor (ECPS) and effective cost per favorable outcome (ECPFO).ResultsThe study population comprised 154 patients. Reasons for ICU admission were: decreased consciousness level (47%) and need for respiratory support (40%). There were 68 (44%) 1 year survivors, of which 27 (18%) had a favorable outcome. High age (odds ratio [OR] 0.95, 95% confidence interval [CI] 0.91–0.98) and high hospital admission National Institutes of Health Stroke Scale score (OR 0.92, 95% CI 0.87–0.97) were independent predictors of poor outcomes. Increased age had a cost ratio of 0.98 (95% CI 0.97–0.99) per added year. The ECPS and ECPFO were 115,628€ and 291,210€, respectively.ConclusionsTreatment of AIS in the ICU is resource‐intense, and in an era predating mechanical thrombectomy the outcome is often poor, suggesting a need for further research into cost‐efficacy of ICU care for AIS patients.

Leptomeningeal carcinomatosis from duodenal papillary carcinoma

A woman in her 50s presented with ataxia and repeated falls during 2nd line S-1 therapy for duodenal papillary carcinoma with metastasis. She was diagnosed with leptomeningeal carcinomatosis based on gadolinium contrast-enhanced magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) examination, although plain computed tomography (CT) and MRI of the head showed no intracranial occupying lesions. This is a rare leptomeningeal carcinomatosis case with duodenal papillary carcinoma as the primary lesion, although aggressive treatment was not possible due to the decreased consciousness level.

A Case Report: Diabetic Ketoacidosis in Patient with type 1 Diabetes Mellitus with Complication Septic Shock and AKI Stage III on HD Triggered by Perianal Abscess

Introduction. Diabetic ketoacidosis (DKA) is an acute, life-threatening complication in diabetes mellitus. Infection is a common precipitating cause of diabetic ketoacidosis (DKA) in known diabetic patient, and diabetic ketoacidosis (DKA) often presents as the first symptom of an undiagnosed diabetes. diabetic ketoacidosis (DKA) is diagnosed with combination of hyperglicaemia, acidosis metabolic and ketonuria.&#x0D; Case Presentation. A 27 years old male patient, admitted to Intensive Care Unit with decrease level of consciousness (GCS 3), he was intubated and present with respiratory distress, metabolic acidosis, high glucose level, ketonuria with renal failure as a target organ. Patient known has perianal abscess as a triggered of diabetic ketoacidosis (DKA), turn into septic shock and underwent debridement surgery to source control the infection. The patient was treated in intensive care unit for 9 days, and sent to ward with GCS 15 an no sequelae of organ failure. The treatment of diabetic ketoacidosis (DKA) should include correcting the often substantial hypovolemia, the hyperglycemia, electrolyte imbalance and the triggering factor of diabetic ketoacidosis (DKA).&#x0D; Conclusion. Prompt surgical intervention, antibacterial therapy, rapid restoration of glycemic control are crucial to prevent mortality in diabetes mellitus patients complicated with abscess.

Tramadol Poisoning: A Systematic Review of Studies in Iran

Background: According to statistics, tramadol use is extremely prevalent in Iran. Besides, tramadol overdose is mostly observed in young individuals. Given the significance of this issue and the increasing prevalence of tramadol use in Iran, this study aimed to systematically review tramadol poisoning in Iran. Methods: In this review, a search was conducted in Persian databases of IranMedex, SID, Medlib, Magiran, as well as Google Scholar using the keywords of “poisoning and tramadol” without a time limitation. Results: Some of the main issues related to tramadol poisoning were as follows: the majority of cases consumed tramadol to commit suicide; most tramadol consumers were aged below 30 years; the majority of patients with tramadol poisoning were single and male; tramadol was mostly used orally; in most studies, patients were hospitalized for &gt;24 hours; the majority of patients concomitantly took other medications with tramadol; in most studies, patients had a history of tramadol use; most studies reported a relationship between tramadol dose and seizures, and the most common cause of hospital referral was decreased consciousness level. Conclusion: Tramadol misuse and poisoning could lead to seizures and often death. Besides, most cases with tramadol poisoning were aged below 30 and consumed tramadol to commit suicide. Thus, it is crucial to improve the youth’s awareness about tramadol use, develop methods to prevent suicides, and limit access to this drug, especially in young adults.

Poppy Intoxication in Infants and Children: Hazards of a Folk Remedy.

To study the clinical and laboratory profile in infants and children presented in the tertiary care hospital with poppy intake and to compare the profile between those who survived with those who died. Observational study. Study Place and Duration: Department Of Paediatrics, Mardan Medical Complex, Mardan, KPK, Pakistan from January 2019 to January 2020. All the infants and children who reported during research period with signs and symptoms (one or more) of opium poppy intoxication, i.e. meiosis, respiratory depression and decreased consciousness level along with confirmed history of giving poppy at home. A total of 32 cases of opium poppy intoxication were admitted. Their age ranged from one month to 23 months, mean age was 7.22 + 5.43 months. Out of them, 15 (46.87%) infants and children survived, and 17 (53.13%) died, (p<0.001). The children who survived had significantly shorter period of time between poppy over-dose and admission in hospital as compared to those who had died (6.0 + 2.56 hours versus 12.47 + 4.14 hours, p<0.001). There was significantly high mortality in children who were given poppy powder mixed in water, out of 17 cases 13 died and 4 survived. Low respiratory rate, decreased oxygen saturation, aspiration pneumonia, apneic spells, cyanosis and leukocytosis >15000cc had significant effect on mortality. Poppy opium is very dangerous and hazardous for infants as it depresses respiration, causes coma; and can be fatal. People need to be educated to curb this harmful practice and authorities need to take necessary actions to stop the sale of poppy at shops and stores. Key Words: Poppy, poisoning/Intoxication, Infants, Meiosis, Apneic spell.

Abstract P47: Immediate Clinical Improvement Occurs in Patients With Aneurysmal Subarachnoid Hemorrhage and Delayed Cerebral Ischemia Treated With Hypertension Induction or Inotropics

Introduction: Delayed cerebral ischemia (DCI) is one of the main determinants of prognosis in aneurysmal subarachnoid hemorrhage (aSAH). Hypertension induction (HI) and inotropics are frequently used strategies to treat DCI. However, little is known about clinical improvement immediately after those therapies. Methods: All patients with aSAH admitted to our hospital from 2016 to 2018 were evaluated. DCI was defined as a new focal neurological deficit or decrease in level of consciousness or the appearance of new infarctions on brain imaging. Patients who developed DCI and received vasopressors or inotropics and were included in the study. They were evaluated before (t0), 45 (t1) and 90 (t2) minutes after therapy initiation using NIHSS scores and Glasgow Coma Scale (GCS). Results: A total of 98 aSAH were evaluated, and 21 of them developed DCI (21.4%). Six patients received both treatment strategies, leading to a total of 27 DCI treatments (norepinephrine =12, milrinone =15). Mean NIHSS score had a significant decrease in t1 and t2 when compared to t0 (17 [95%CI 13-24], 16 [95%CI 11-23], 15 [95%CI 9-22], p&lt;0.001 and p&lt;0.002). The same happened among those treated with IH (t0=18 [95%CI 13-25]; t1=16 [95%CI 11-23], p=0.002; t2=14 [95%CI 9-22], p=0.027) and with milrinone (t0=17 [95%CI 12-24]; t1=15 [95%CI 10-23], p=0.007; t2=14 [95%CI 9-23], p=0.001). Mean GCS had a significant improvement in t1, that was not sustained in t2 (9 [95%CI 8-11], 10 [95%CI 9-12], 10 [95%CI 9-12], p=0.008 and p=0.098). In those treated with HI GCS scores did not change significantly (t0=9 [95%CI 7-11]; t1=10 [95%CI 8-12], p=0.054; t2=10 [95%CI 8-12], p=0.177). Those treated with inotropics significantly improved across time (t0=10 [95%CI 8-12]; t1=11 [95%CI 9-13], p=0.004; t2=11 [95%CI 9-13], p=0.001). Conclusions: DCI treatment with HI or inotropic therapy seems effective in immediately improving neurological deficits in patients with aSAH and DCI.

Reality of traffic injuries attributable to preceding decreased level of consciousness.

AimAlthough decreased level of consciousness (DLOC) while driving may lead to serious accidents involving drivers and people around them, including passengers and pedestrians, few studies have assessed traffic injuries attributable to preceding DLOC. We aimed to identify factors suggestive of a DLOC preceding traffic injury during initial examination.MethodsThis study included 193 drivers who were brought to our facility during the 1‐year period from January to December 2018. The drivers were divided into those with and without DLOC for comparison and analysis. Data on age, sex, causes of DLOC, and medical history were retrospectively reviewed from medical records.ResultsOf these 193 drivers, 58 (30.1%) had experienced preceding DLOC. The following factors suggested possible episodes of preceding DLOC: a single‐vehicle accident (odds ratio [OR] 3.59; 95% confidence interval [CI] 1.76–7.34; P < 0.001) and histories of hypertension (OR 2.64; 95% CI 1.13–6.15; P = 0.0248) and psychiatric disorders (OR 3.49; 95% CI 1.08–11.3; P = 0.0370). The causes of DLOC were endogenous diseases in 20 drivers (34.3%), dozing off episodes in 19 (32.8%), and acute alcohol intoxication in 11 (19.0%).ConclusionBefore traffic accidents, 30.1% of drivers experienced DLOC. Single‐vehicle accidents and histories of hypertension and psychiatric disorders were factors suggestive of preceding DLOC.

Clinical profile of patients with baclofen poisoning in an academic medical center

Context: Baclofen overdose acutely affects the nervous system and induces a decrease in the consciousness level, coma, and death. The diagnosis of it is based on the patient’s history and clinical findings. Aims: The present study aims to investigate baclofen-induced poisoning based on medical reports in a 5-year period. Materials and Methods: This retrospective study was conducted in Loghman Hakim Hospital, Tehran, Iran. The medical profile of 135 patients with baclofen overdose was read out, collected, and analyzed using SPSS version 18. Results: The average age of 135 patients was 26.37±18.73 years. The majority of them were female (68.1%) and intentional attempts (66.7%). There were 117 patients (86.7%) with central nervous system symptoms. The most common nervous finding was drowsiness (n = 53, 45.3%). There was no patient with seizures. There was a significant statistical relationship between the dose of baclofen and consciousness level (GCS ≤12: 302.61 ± 236.40 mg, and GCS >12: 162.21 ± 121.02 mg, P < 0.001). Conclusion: Baclofen overdose should be considered in patients referred to the emergency department with drowsiness symptoms and decreased consciousness level. Because of this poisoning, it has no specific symptoms and is common in female and young people.

Extrapulmonary Manifestations of Coronavirus Disease 2019: A Narrative Review

Background and Aim: Coronaviruses are a large family of viruses that are known to cause respiratory tract infections in humans. SARS-CoV-2 is a new type of this family initiated in late 2019 and its related disease is known as Coronavirus Disease 2019 (COVID-19). Common symptoms of COVID-19 include fever, dry cough, fatigue, myalgia, arthralgia and shortness of breath. Methods &amp; Materials: In This narrative review a literature search was conducted in scientific databases including Google Scholar and PubMed to find studies published from December 2019 to May 10 2020 on the role the extrapulmonary manifestations of COVID-19. Ethical Considerations: Ethical issues (including plagiarism, misconduct, data fabrication, falsification, double publication or submission, redundancy) have been completely observed by the authors. Results: In addition to respiratory symptoms, involvement of various organs such as gastrointestinal tract, nervous system, skin, olfactory system, cardiovascular system, liver, kidney, and eyes was also reported. Extrapulmonary manifestations of COVID-19 included anosmia, ageusia, skin rash, chickenpox-like blisters, acute cardiac failure with increased troponin levels, kidney inflammation and edema, common gastrointestinal symptoms (e.g. diarrhea, nausea and vomiting), elevated liver enzyme levels, neurological disorders (e.g. stroke), nonspecific symptoms (e.g. headache and dizziness), and decreased consciousness level. Conclusion: The hypothetical mechanisms of various organ involvements during COVID-19 include immune-mediated inflammation such as cytokine storm, respiratory dysfunction, hypoxemia, cellular damage, or combination of these mechanisms. Further studies should be conducted on the causes of various COVID-19-induced damages to determine the exact relationship between the pathogenesis, prognosis and severity of the disease.

A Case Report : Diabetic Ketoacidosis in patient with type 1 Diabetes Mellitus with Complication Septic Shock and AKI Stage III on HD Triggered by Perianal Abscess

ABSTRACT&#x0D; Introduction. Diabetic ketoacidosis (DKA) is an acute, life-threatening complication in diabetes mellitus. Infection is a common precipitating cause of diabetic ketoacidosis (DKA) in known diabetic patient, and diabetic ketoacidosis (DKA) often presents as the first symptom of an undiagnosed diabetes. diabetic ketoacidosis (DKA) is diagnosed with combination of hyperglicaemia, acidosis metabolic and ketonuria.&#x0D; Case Presentation. A 27 years old male patient, admitted to Intensive Care Unit with decrease level of consciousness (GCS 3), he was intubated and present with respiratory distress, metabolic acidosis, high glucose level, ketonuria with renal failure as a target organ. Patient known has perianal abscess as a triggered of diabetic ketoacidosis (DKA), turn into septic shock and underwent debridement surgery to source control the infection. The patient was treated in intensive care unit for 9 days, and sent to ward with GCS 15 an no sequelae of organ failure. The treatment of diabetic ketoacidosis (DKA) should include correcting the often substantial hypovolemia, the hyperglycemia, electrolyte imbalance and the triggering factor of diabetic ketoacidosis (DKA).&#x0D; Conclusion. Prompt surgical intervention, antibacterial therapy, rapid restoration of glycemic control are crucial to prevent mortality in diabetes mellitus patients complicated with abscess.

Fractal dimension of cortical functional connectivity networks & severity of disorders of consciousness.

Recent evidence suggests that the quantity and quality of conscious experience may be a function of the complexity of activity in the brain and that consciousness emerges in a critical zone between low and high-entropy states. We propose fractal shapes as a measure of proximity to this critical point, as fractal dimension encodes information about complexity beyond simple entropy or randomness, and fractal structures are known to emerge in systems nearing a critical point. To validate this, we tested several measures of fractal dimension on the brain activity from healthy volunteers and patients with disorders of consciousness of varying severity. We used a Compact Box Burning algorithm to compute the fractal dimension of cortical functional connectivity networks as well as computing the fractal dimension of the associated adjacency matrices using a 2D box-counting algorithm. To test whether brain activity is fractal in time as well as space, we used the Higuchi temporal fractal dimension on BOLD time-series. We found significant decreases in the fractal dimension between healthy volunteers (n = 15), patients in a minimally conscious state (n = 10), and patients in a vegetative state (n = 8), regardless of the mechanism of injury. We also found significant decreases in adjacency matrix fractal dimension and Higuchi temporal fractal dimension, which correlated with decreasing level of consciousness. These results suggest that cortical functional connectivity networks display fractal character and that this is associated with level of consciousness in a clinically relevant population, with higher fractal dimensions (i.e. more complex) networks being associated with higher levels of consciousness. This supports the hypothesis that level of consciousness and system complexity are positively associated, and is consistent with previous EEG, MEG, and fMRI studies.

EEG efficiency of detecting sub-clinical seizures in critical ill patients: Retrospective study

Introduction Continuous electroencephalography (cEEG) monitoring in the critical care setting demonstrates a linear increase in seizure incidence with declining mental status. Delayed diagnosis and treatment of non-convulsive status epilepticus (NCSE) may lead to increased mortality. No clinical or paraclinical parameter can reliably distinguish elderly patients with delirium with or without patterns compatible with NCSE in the absence of cEEG monitoring. EEG may be over-utilized in our hospital ICUs & usually ordered for most of the patient with altered mental status. We aimed to evaluate the efficiency of EEG to detect subclinical seizures in patients with altered level of consciousness. Methods Single-center retrospective study comprised 24 patients who were hospitalized in King Fahad Specialist Hospital in Dammam between January2017-December2018 due to change of their level of consciousness. Descriptive analysis was used to study the factors involved in the patient findings. Findings/prognosis Only 1 of the 4 patients with subclinical seizures had periodic lateralizing epileptogenic discharges. Only one of the patients with the subclinical seizures was known to have seizure. Last 2 patients were post cardiac arrest & one had brain metastasis. 2 of the patients with the subclinical seizure died few days later because of the seizure or drug side effects. Conclusion Patient with decrease level of consciousness after clinical seizure increase suspicion of subclinical seizure, therefore, early diagnosis of the subclinical seizure allows early management and most likely better outcome. However, there was an over utilization of EEG found in through the study.

Characteristics of Children with Diabetic Ketoacidosis Treated in Pediatric Intensive Care Unit: Two-Center Cross-Sectional Study in Croatia.

Background and objective: There is an increasing risk of type 1 diabetes mellitus (T1D) among children in Croatia. Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in children with T1D, with cerebral edema as the most severe complication. Since early recognition of cerebral edema leads to a better outcome, it is important that patients with moderate or severe DKA are closely monitored and treated in pediatric intensive care units (PICUs). The aim of this study is to investigate clinical and laboratory parameters, as well as complications in children treated in PICUs because of DKA. Materials and methods: Patients treated due to DKA in the PICU of the University Hospitals of Split and Osijek from 2013 to 2017 were included in this study. Retrospectively collected data included age, gender, clinical signs and symptoms, and various laboratory parameters. After dividing subjects into two groups: Newly diagnosed with T1D (NT1D) and previously diagnosed with T1D (PT1D), collected data were compared between the two groups. Results: A total of 82 patients were enrolled. Those with NT1D were more often treated in the PICU, with two of them developing cerebral edema. Dehydration was the most frequent clinical sign, found in 95% of patients at admission. Decreased consciousness level was found in 41.5% of patients, with majority of them being somnolent. No difference was found between NT1D and PT1D. Additionally, there was no significant difference regarding laboratory data at admission. Conclusions: More children with NT1D required treatment in the PICU due to DKA with two of them developing cerebral edema. Since cerebral edema is a life-threatening condition, treatment of patients with moderate or severe DKA in PICUs will provide necessary monitoring enabling early recognition, treatment, and better treatment outcome. To minimize the incidence of DKA among patients with NT1D, it is important to continuously carry out public health education programs aimed at early identification of signs and symptoms of T1D.

A case of recurrent posterior reversible encephalopathy syndrome

Purpose: To report a case of recurrent posterior reversible encephalopathy syndrome (PRES) after post-partum eclampsia. Case Report: A 22-year-old woman, para 3+0, presented with headaches, decrease level of consciousness, and convulsions after home delivery. Her second delivery was an emergency cesarean section due to eclampsia with PRES at 30 weeks of gestation. On examination she was unconscious with blood pressure of 220/120. She was intubated and transferred to the intensive care unit. Computer tomography scans confirmed the diagnosis of recurrent PRES. She recovered completely with supportive treatment and was discharged home one week after admission. Conclusion: Posterior reversible encephalopathy syndrome may recur in a subsequent pregnancy.